Endocrine Surgery Thyroid Center

The thyroid gland is an important gland in the endocrine system. Located in the neck, the thyroid gland consists of two lobes which sit to the right and the left of the trachea, or windpipe. The two lobes are connected by a thyroid tissue that runs across the front of the trachea.

The function of the thyroid is extremely important. It produces a hormone called thyroxine, which, once released into the bloodstream, controls the body's metabolism, determines the rate at which the heart moves, and the movement of the gastrointestinal tract. Thyroxine affects bone loss as well as how the body makes and uses sugar. The pituitary gland plays an important role, releasing its own hormone called thyroid stimulating hormone, or THS, which stimulates the thyroid to make and release more thyroxine into the body.

Thyroid Disorders

Thyroid Nodule

The term thyroid nodule refers to any abnormal growth of thyroid cells into a lump within the thyroid gland. They may occur as single nodules or multiple nodules in the setting of an enlarged thyroid (nontoxic nodular goiter). Thyroid nodules are very common occurring in up to 30 percent of the population. Though most thyroid nodules are benign, solitary thyroid nodules more than 2 cm in size have an increased risk of being malignant.

Thyroid Nodule Symptoms: Most thyroid nodules do not cause symptoms. If symptoms are present however, they may include:

Pressure in the neck

Difficulty swallowing

Difficulty breathing

Hoarseness

Chronic cough

Evaluation: Thyroid nodules should be worked up in a systematic, multidisciplinary setting. Depending on the patient's clinical presentation, the work-up includes:

Physical examination

Detailed family history

Thyroid ultrasound

Thyroid scan

Fine needle aspiration biopsy with or without ultrasound guidance

Thyroid Cancer

Thyroid cancer is one of the few cancers in which the number of new cases is increasing. According to the American Cancer Society, it is estimated that 47,000 new cases of thyroid cancer are diagnosed each year in the US. Women over the age of 45 years have experienced the most dramatic increase in thyroid cancer. Papillary thyroid cancer is the most common type of thyroid cancer (80 percent). Other types of thyroid cancer include follicular, medullary, anaplastic, and lymphoma.

Thyroid Cancer Symptoms: The most important signs of thyroid cancer are a lump or nodule in the thyroid gland or a chronically hardened lymph gland in the neck area. Although most thyroid cancers do not cause symptoms, if present, they may include:

Pain in the neck, jaw or ear

Difficulty swallowing

Difficulty breathing

Hoarseness

Firm neck lymph nodes

Chronic cough

Pressure in the neck

Diagnosis: A diagnosis of thyroid cancer is made based upon the results of a fine needle aspiration biopsy of a thyroid nodule or neck lymph node in the neck. Ancillary studies may play a role in the diagnosis and surgical planning including:

Hyperthyroidism

Definition: The term 'hyperthyroidism' refers to any condition in which there is too much thyroid hormone in the body or an overactive thyroid gland. It is a common disorder, affecting over 2 million Americans, most of whom are women. There are several types of hyperthyroidism, each associated with a different particular cause and different options for therapy which include:

Graves' disease (also called diffuse toxic goiter) caused by antibodies in the blood, which stimulate the thyroid to grow and produce excess hormone

Toxic multinodular goiter, an enlarged, lumpy thyroid gland in which individual thyroid nodule(s) are responsible for excess thyroid hormone production

Thyroid adenoma, or a single nodule within the thyroid gland

Thyroiditis (inflammation of the thyroid), a self-limiting disease possibly caused by an infection and often associated early on with an increased release of thyroid hormone

Changes in vision, eye irritation, or exophthalmos: significant protrusion of the eyes due to swelling of the tissue behind them causing elevation of the upper eye lids (with Graves' disease)

Diagnosis: The diagnosis of hyperthyroidism is made on the basis of findings during a physical exam and confirmed by laboratory tests and complementary functional imaging of the thyroid gland (iodine-uptake scans).

Thyroid stimulating hormone (TSH)- the single best screening test for hyperthyroidism; most types result in a below average level

Levels of thyroid hormone (thyroxine, or T4; triiodothyronine, or T3)

Thyroid-stimulating antibodies that cause Graves' disease

Radioactive iodine scan to see whether the entire thyroid gland is overactive

Clues that hyperthyroidism is caused by Graves' disease

Presence of Graves' eye disease

Myxedema

Enlarged thyroid or goiter

History of other family members with thyroid problems (hyperthyroidism or hypothyroidism)

Family members with other autoimmune disorders (premature gray hair, juvenile diabetes, rheumatoid arthritis, pernicious anemia due to lack of vitamin B12, or vitiligo)

Thyroid Surgery, including Minimally Invasive Thyroid Surgery

Mount Sinai offers a comprehensive, multidisciplinary approach to caring for patients with thyroid disorders. Our team of thyroid specialist can oversee each patient's care from beginning to end in a "one stop" clinical environment, where all the patient's thyroid needs can be met.

We perform simple and complex operations, such as minimally invasive thyroid surgery which leaves no scarring, total thyroid removal for cancer, lymph node dissections, and thyroid surgery for benign conditions such as symptomatic goiter. We specialize in minimally invasive surgery techniques including:

Video-assisted thyroidectomy

Mini-incision thyroid surgery

Thyroid surgery under local anesthesia

Endoscopic transaxillary thyroid surgery

Robotic-assisted thyroid surgery

Intraoperative nerve monitoring

We perform many of our thyroid surgeries at the Mount Sinai Ambulatory Surgery Center [PDF], a state-of-the-art outpatient surgery suite that is just steps from 5th Avenue and Central Park.